Methods and compositions for the treatment of acne

ABSTRACT

The present application is directed to regimens, methods of treatment, and compositions for the treatment of acne in a subject suffering therefrom.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a Continuation Application of U.S. patentapplication Ser. No. 16/514,033, filed Jul. 17, 2019, which is aContinuation Application of U.S. patent application Ser. No. 16/033,257,filed Jul. 12, 2018, which claims the benefit of U.S. Ser. No.62/531,396, filed Jul. 12, 2017 which is incorporated in its entiretyherein by reference.

FIELD OF THE INVENTION

The present application is directed to regimens, methods of treatmentand compositions for the treatment of acne in a subject sufferingtherefrom.

BACKGROUND OF THE INVENTION

Acne vulgaris is a common condition of the pilo-sebaceous units of theskin (hair follicles and oil glands). Acne is the most common skindisorder in the United States, affecting 40-50 million Americans. Acneusually begins in puberty, but the condition is not restricted to anyage group. Approximately 85% of people between the ages of 12 and 24experience at least minor, most often on the face, chest, and back[Bhate and Williams].

Acne is caused by four major factors: (1) production of oil by enlargedoil glands in the skin, (2) blockage of the hair follicles that releaseoil, (3) growth of bacteria, called Propionibacterium acnes (P. acnes),within the hair follicles and (4) inflammatory/immune response to P.acnes.

The pathophysiologic features of acne suggest that combination therapyshould be utilized as early as possible to simultaneously attack themultiple pathogenic factors of the condition [Gollnick and Cunliffe].Antimicrobials have been a mainstay of acne treatment for many years,having multiple mechanisms of action. The most important may be theability of antibiotics to decrease the number of P. acnes in and aroundthe follicle. They have a bacteriostatic effect on P. acnes, whichprevents the bacteria from producing pro-inflammatory molecules [Leydenet al.].

In clinical practice, it is common for physicians to prescribe multipletopical products for acne. Topical products are applied one or two timesa day by the patient. However, many of these compounds are irritatingwith resultant development of facial erythema and discontinuation of theproducts or noncompliance with therapy. Benzoyl peroxide (BPO) and alltrans retinoic acid (ATRA) are two active ingredients with differentpharmacological actions that are commonly used for the treatment ofacne.

Topical retinoids are keratinization inhibitors. They work by decreasingthe cohesiveness of follicular epithelial cells. This, results in aninhibition in the formation of microcomedones, preventing the formationof mature comedones and inflammatory lesions [Gollnick and Cunliffe].Use of retinoids promotes the normal desquamation of follicularepithelium. The action of the retinoid may enhance the penetration ofother topical compounds used to treat acne.

BPO is a commonly used topical antibacterial agent for acne availableeither by prescription in combinations or over the counter (OTC). BPOhas been found to be lethal to P. acnes as well as other bacteria thatmay reside on the skin. So far there has been no indication of anybacteria developing a resistance to BPO. It has also been demonstratedthat BPO has keratolytic activity contributing to its efficacy intreating comedonal acne [Tanghetti]. BPO reduces the cohesiveness of thecells of the stratum corneum, thus improving topical drug deliverythrough the epidermal barrier.

Silica microcapsule systems have been developed to overcome many of thelimitations (such as degradation and irritation) of standardpharmaceutical formulations involving multiple active ingredients. Theencapsulation of active ingredients in silica microcapsules serves toprotect components in the formulation from interacting with one anotherand, as a consequence, increases overall formulation stability. Silicais chemically inert, photochemically and physically stable, and safe fortopical use.

Applicant's silica encapsulated products meet the criteria forcategorical exclusion defined in 21 CFR 25.31(e), and that to theknowledge of Applicant, no extraordinary circumstances exist as definedin 21 CFR 25.21. Thus, no environmental assessment is required accordingto 21 CFR 25.20(1). For the case of encapsulated BPO(E-BPO)/encapsulated ATRA (E-ATRA), microencapsulation of both BPO andtretinoin protects the tretinoin from oxidative decomposition by BPO,thereby enhancing the stability for this novel combination product andensuring a suitable clinical and commercial shelf life (U.S. Pat. No.8,617,580 and US 2012/0202695).

Clinicians have been reluctant to prescribe topical retinoids and BPOconcurrently due to a belief that the BPO may result in oxidation anddegradation of the tretinoin molecule, thereby reducing itseffectiveness, and prefer to recommend the BPO or an antibiotic/BPOcombination to be applied in the morning and tretinoin at night (Yan AC. Current concepts in acne management. Adolesc. Med. Clin. 2006;17(3):613-637.)

Another publication (Emmy Graber, Treatment of Acne Vulgaris,UpToDate.com, July 2016) states “topical tretinoin should NOT be appliedat the same time as benzoyl peroxide”, despite the known fact that newerretinoid compositions like Retin A microspheres (MICROSPONGE® System)have less interaction or no short term interaction with BPO. Obviously,concomitant administration of tretinoin and BPO is taught away by thispublication.

Unlike adapalene, which is often combined with BPO, tretinoin issignificantly more irritant to the skin and since BPO is also irritant,it has been feared that the two APIs together will create unacceptablecutaneous side effects. Also, BPO is known to oxidize tretinoin andhence it was feared that their interaction on the skin when administeredtogether will diminish the therapeutic effect of tretinoin. Thus, whilethere are some reports in the literature on the value of both compoundsbeing administered one in the morning and the other in the evening, theverdict up to now was that the two products should not be administeredconcomitantly.

This belief of the medical profession explains why all previous attemptsto solve the stability problem of tretinoin/BPO, such asmicroencapsulation technology, did not yield a commercial product sofar.

Combination topical therapy is the recommended standard of care for themanagement of patients with acne [Gollnick and Cunliffe]. Combinationtherapy targets multiple pathogenic factors: abnormal follicularkeratinization, P. acnes proliferation and inflammation. Combining theseparate product applications into a single delivery system wouldprovide the patient with the convenience of a single product, thusimproving patient adherence and improving treatment outcomes.

SUMMARY OF THE INVENTION

In some embodiments, this invention provides a method of treating acnecomprising: topically applying onto an affected skin area of a subjectin need thereof, once a day for a period of time of up to 12 weeks, atopical medicament which comprises the active agents:

-   -   Tretinoin or a pharmaceutically acceptable salt thereof, in an        amount of about 0.1% weight; and    -   Benzoyl Peroxide in an amount of about 3% weight.

In some embodiments, in the method of this invention, the score of atleast one parameter evaluated by an Investigator Cutaneous SafetyAssessment is synergistically lower than the score of the parametersevaluated with the same treatment regimen with each of the active agentsseparately. In another embodiment, the at least one parameter evaluatedby the Investigator Cutaneous Safety Assessment is selected fromErythema, Scaling, Pigmentation and any combinations thereof.

In some embodiments, in the method of this invention, the score of atleast one parameter evaluated by a Local Tolerability Score issynergistically lower than the score of the parameters evaluated withthe same treatment regimen with each of the active agents separately. Inanother embodiment, the at least one parameter evaluated by the LocalTolerability score is selected from Itching, Burning, Stinging, and anycombinations thereof.

In some embodiments, in the method of this invention, the method reducesat least one of:

-   -   (i) the number of inflammatory acne lesions by at least 50%; or    -   (ii) the number of non-inflammatory acne lesions by at least        40%.

In other embodiments, the method reduces the number of inflammatory acnelesions by at least 50%; and the number of non-inflammatory acne lesionsby at least 40%.

In other embodiments, the method improves the IGA success rate by atleast 20% compared to the baseline score.

In other embodiments, in the method of this invention, the score of atleast one efficacy parameter is synergistically higher than theparameter evaluated with the same treatment regimen with each of theactive agents separately. In another embodiment, the efficacy parameteris selected from at least one of IGA success rate, mean reduction ininflammatory lesions count, mean reduction in non-inflammatory lesioncount, mean reduction in acne symptom domain, mean reduction in acneimpact domain and mean reduction in verbal rating scale.

In other embodiments, in the method of this invention, after two weeksstorage at 40° C. of the topical medicament, the concentration ofall-trans 5,6-epoxy retinoic acid is lower than 1%. In otherembodiments, in the method of this invention, after two weeks storage at40° C. of the topical medicament, the degradation of said tretinoin isless than 2.5%.

In other embodiments, in the method of this invention, the methodpotentiates the action of tretinoin in the treatment of acne.

In other embodiments, in the method of this invention, the release rateof said tretinoin from said topical medicament is less than 60% per h.In other embodiment, the release rate of said tretinoin from saidtopical medicament is less than 60% per h in a medium of 70% IPA(isopropyl alcohol) and 30% water at room temperature.

In other embodiments, in the method of this invention, the at least oneactive agent of said medicament is encapsulated in a shell. In anotherembodiment, both active agents, BPO and Tretinoin, of the medicament areencapsulated in a shell. In another embodiment, the shell is a metaloxide or semi-metal oxide inorganic shell.

In other embodiments, the topical medicament in a single dose medicamentcomprising both said active agents.

BRIEF DESCRIPTION OF THE DRAWINGS

In order to better understand the subject matter that is disclosedherein and to exemplify how it may be carried out in practice,embodiments will now be described, by way of non-limiting example only,with reference to the accompanying drawings, in which:

FIG. 1 shows the HPLC chromatogram of an embodiment composition of theinvention comprising 0.05% E-ATRA and 3% E-BPO eluted with acetonitrileand acetic acid 1% in water on a Zorbax RX-C18 3.5 mμ, 4.6*75 mm column,showing the RRT 0.44 product (all-trans 5,6-epoxy retinoic acid) atretention time of about 3.5 min (RRT product calculated relative to theATRA peak at 7.8 min).

DETAILED DESCRIPTION OF THE PRESENT INVENTION

In the first aspect, the present invention provides a regimen for thetreatment of acne comprising: topically applying onto an affected skinarea of a subject in need thereof, once a day for a period of time of upto 12 weeks, a topical medicament which comprises the active agents:

-   -   Tretinoin or a pharmaceutically acceptable salt thereof, in an        amount of between about 0.05% to about 0.1% weight; and    -   Benzoyl Peroxide in an amount of at least about 3% weight.

In a further aspect, the present invention provides a regimen for thetreatment of acne comprising: topically applying onto an affected skinarea of a subject in need thereof, once a day for a period of time of upto 12 weeks, a topical medicament which comprises the active agents:

-   -   Tretinoin or a pharmaceutically acceptable salt thereof, in an        amount of between about 0.05% to about 0.1% weight; and    -   Benzoyl Peroxide in an amount of at least about 3% weight;

wherein the score of at least one parameter evaluated by an InvestigatorCutaneous Safety Assessment is synergistically lower than the score ofthe parameters evaluated with the same treatment regimen with each ofthe active agents separately. In another embodiment, the topicalmedicament comprises about 0.1% tretinoin and about 3% benzoyl peroxide.

In some embodiments, the at least one parameters evaluated by theInvestigator Cutaneous Safety Assessment is selected from Erythema,Scaling, Pigmentation and any combinations thereof.

In yet another aspect, the present invention provides a regimen for thetreatment of acne comprising: topically applying onto an affected skinarea of a subject in need thereof, once a day for a period of time of upto 12 weeks, a topical medicament which comprises the active agents:

-   -   Tretinoin or a pharmaceutically acceptable salt thereof, in an        amount of between about 0.05% to about 0.1% weight; and    -   Benzoyl Peroxide in an amount of at least about 3% weight;

wherein the score of at least one parameter evaluated by a LocalTolerability Score is synergistically lower than the score of theparameters evaluated with the same treatment regimen with each of theactive agents separately. In another embodiment, the topical medicamentcomprises about 0.1% tretinoin and about 3% benzoyl peroxide.

In some embodiments, the at least one parameter evaluated by the LocalTolerability score is selected from itching, burning, stinging, and anycombinations thereof.

In a further aspect, the present invention provides a regimen for thetreatment of acne comprising: topically applying onto an affected skinarea of a subject in need thereof, once a day for a period of time of upto 12 weeks, a topical medicament which comprises the active agents:

-   -   Tretinoin or a pharmaceutically acceptable salt thereof, in an        amount of between about 0.05% to about 0.1% weight; and    -   Benzoyl Peroxide in an amount of at least about 3% weight;

wherein said regimen improves the IGA success rate by at least 20%compared to the baseline score. In another embodiment, the topicalmedicament comprises about 0.1% tretinoin and about 3% benzoyl peroxide.

In some embodiments, said regimen improves the IGA success rate byreducing the number of acne lesions and improving the clinical conditionof a patient in need thereof as compared to their baselinecondition/score.

In another one of its aspects, the present invention provides a regimenfor the treatment of acne, comprising topically applying onto anaffected skin area of a subject in need thereof, once a day for a periodof time of up to 12 weeks, a topical medicament which comprisestretinoin or a pharmaceutically acceptable salt thereof, as a singleactive agent in an amount of between about 0.05% to about 0.1% weight;wherein said active agent is encapsulated in a shell; and wherein thescore of at least one parameter evaluated by an Investigator CutaneousSafety Assessment is lower than the score of the parameters evaluatedwith the same treatment regimen using a non-encapsulated active agent.In another embodiment, the topical medicament comprises about 0.1%tretinoin and about 3% benzoyl peroxide.

In a further aspect, the present invention provides a regimen for thetreatment of acne, comprising topically applying onto an affected skinarea of a subject in need thereof, once a day for a period of time of upto 12 weeks, a topical medicament which comprises tretinoin or apharmaceutically acceptable salt thereof, as a single active agent in anamount of between about 0.05% to about 0.1% weight; wherein said activeagent is encapsulated in a shell; and

wherein the score of at least one parameter evaluated by LocalTolerability Score is lower than the score of the parameters evaluatedwith the same treatment regimen using a non-encapsulated active agent.In another embodiment, the topical medicament comprises about 0.1%tretinoin and about 3% benzoyl peroxide.

In some embodiments, the amount of said encapsulated tretinoin is about0.1% weight.

In another one of its aspects, the present invention provides a regimenfor the treatment of acne comprising: topically applying onto anaffected skin area of a subject in need thereof, once a day for a periodof time of up to 12 weeks, a topical medicament which comprises theactive agents:

-   -   Tretinoin or a pharmaceutically acceptable salt thereof, in an        amount of between about 0.05% to about 0.1% weight; and    -   Benzoyl Peroxide in an amount of at least about 3% weight;

wherein said regimen reduces at least one of:

the number of inflammatory acne lesions by at least 50%; or

(ii) the number of non-inflammatory acne lesions by at least 40%.

In another embodiment, the topical medicament comprises about 0.1%tretinoin and about 3% benzoyl peroxide. In another embodiment, thetopical medicament used in the regimen treatment or method of treatmentof this invention is described in US patent publication 2013/0095185,which is incorporated herein by reference.

In some embodiments, the amount of said tretinoin is about 0.1% weightand the amount of said benzoyl peroxide is at least about 3% weight. Itshould be noted that the composition having these active agents in theseconcentrations was shown to have unexpected and surprising benefits withrespect to the tolerability of the product (less side effects such asburning and itching, stinging and so forth), safety of the treatment(less erythema, scaling, pigmentation and so forth), and effectivenessof the treatment of acne (treatment with the composition following theregimen of the invention significantly reduced the number ofnon-inflammatory and inflammatory acne lesions). Surprisingly, whenincreasing the concentration of the tretinoin from 0.05% to 0.1%, whilethe efficacy increased, the side effects were not increased and in somecases were even reduced. For example, 44.8% subjects complained aboutburning side effects at 12 weeks of using the composition comprising0.05% tretinoin and 3% benzoyl peroxide (see Table 21), while only 38.1%subjects complained about burning side effect when increasing theconcentration of the tretinoin to 0.1% (see Table 18).

In some embodiments said regimen reduces the number of non-inflammatoryacne lesions by at least 40%. In other embodiments, said regimen reducesthe number of inflammatory acne lesions by at least 50%. In yet furtherembodiments, said regimen reduces the number of inflammatory acnelesions by at least 50%; and the number of non-inflammatory acne lesionsby at least 40%.

In some embodiments, after two weeks storage at 40° C. of the topicalmedicament of the invention, the concentration of RRT (relativeretention time) 0.44, (all-trans 5,6-epoxy retinoic acid, that is themajor tretinoin degradation product) is lower than 1%. In otherembodiments, after two weeks storage at 40° C. of the topical medicamentof the invention, the degradation of said tretinoin is less than 2.5%.

When referring to RRT 0.44 it should be understood to relate to thedegradation product of tretinoin in the presence of BPO as shown in theHPLC chromatography of the composition of the invention after two weeksof storage at 40° C. An example of the RRT product can be seen in FIG. 1at retention time 3.507 min. In other embodiments, RRT 0.44 refers toall-trans 5,6-epoxy retinoic acid represented by the followingstructure:

The invention further provides a method of treating acne, comprisingtopically applying onto an affected skin area of a subject in needthereof, once a day for a period of time of up to 12 weeks, a topicalmedicament which comprises of the active agents: Tretinoin or apharmaceutically acceptable salt thereof, in an amount of between about0.05% to about 0.1% weight; and Benzoyl Peroxide in an amount of atleast about 3% weight; wherein said method potentiates the action oftretinoin in the treatment of acne.

The present invention further provides a regimen for the treatment ofacne comprising: topically applying onto an affected skin area of asubject in need thereof, once a day for a period of time of up to 12weeks, a topical medicament which comprises the active agents: Tretinoinor a pharmaceutically acceptable salt thereof, in an amount of betweenabout 0.05% to about 0.1% weight; and Benzoyl Peroxide in an amount ofat least about 3% weight; wherein the release rate (dissolution rate) ofsaid tretinoin from said topical medicament is less than 60% per h. Insome embodiments, the release rate (dissolution rate) of said tretinoinfrom said topical medicament is less than 50% per h. In someembodiments, the release rate (dissolution rate) of said tretinoin fromsaid topical medicament is less than 45%, 40%, 35%, 30% or 25% per h.

It should be noted that the release rate (dissolution rate) definedherein relates to the measurement (either in vitro or in vivo) of therate at which the active agents (for example tretinoin) is released fromthe topical medicament of the invention, to the extracting media orskin. The release rate is measured using known methods, such as forexample: (1) 70% IPA (isopropyl alcohol) and 30% water and optionally anantioxidant (such as BHT) at room temperature; (2) 60-80% alcohol, ACN(acetonitrile) at room temperature; or (3) 2% Tween 80, IPA in a ratioof 2:1, and optionally an antioxidant (such as BHT) at 32° C.

In some embodiments, said release rate of said tretinoin from saidtopical medicament is less than 60% per h in a medium of 70% IPA(isopropyl alcohol) and 30% water at room temperature.

The invention further provides a regimen for the treatment of acnecomprising: topically applying onto an affected skin area of a subjectin need thereof, once a day for a period of time of up to 12 weeks, atopical medicament which comprises the active agents:

-   -   Tretinoin or a pharmaceutically acceptable salt thereof, in an        amount of between about 0.05% to about 0.1% weight; and    -   Benzoyl Peroxide in an amount of at least about 3% weight;

wherein the score of at least one efficacy parameter is synergisticallyhigher than the parameter evaluated with the same treatment regimen witheach of the active agents separately. In another embodiment, the topicalmedicament comprises about 0.1% tretinoin and about 3% benzoyl peroxide.

In some embodiments of regimen of the present invention, said BenzoylPeroxide is in an amount of about 3% weight. In other embodiments ofregimen of the present invention, said Benzoyl Peroxide is in an amountof about 6% weight. In further embodiments of regimen of the presentinvention, said Benzoyl Peroxide is in an amount of between about 3% toabout 6% weight. In yet further embodiments of regimen of the presentinvention, said Benzoyl Peroxide is in an amount of about 3%, 4%, 5% or6% weight.

In some embodiments, said efficacy parameter is selected from at leastone of IGA success rate, mean reduction in inflammatory lesions count,mean reduction in non-inflammatory lesion count, mean reduction in acnesymptom domain (measured using a patient reported outcome study andincluding symptoms such as for example number of pimples, whiteheads,blackheads, redness), mean reduction in acne impact domain (measuredusing a patient reported outcome study and including symptoms such asfor example sadness, embarrassment, self-consciousness) and meanreduction in verbal rating scale.

As used herein the term “a regimen for the treatment of acne” is usedherein interchangeably with the term “method of treating acne” havingall the same meaning and qualities. The term “regimen” as used hereinshould be understood to relate to a medical treatment regimen regulatingthe treatment of acne in a subject suffering therefrom, including theregulation of the medicament administered (fixed dose combination of theactive agents: tretinoin or a pharmaceutically acceptable salt thereofand BPO), the frequency of administration (i.e. once a day), theduration of treatment (i.e. up to 12 weeks), the method ofadministration (i.e. topical) and the location of administration (i.e.topically applying onto an affected skin area).

When relating to the treatment of “acne” it should be understood torelate to the treatment of a skin condition or disease also known asacne vulgaris in any form or place of its occurrence or severity (mild,moderate, severe or any combinations thereof. In some subjects parts ofarea of the skin may be mildly inflicted while other area of the skin ofthe same individual may be severely inflicted). Mild acne is classicallydefined as open (blackheads) and closed (whiteheads) clogged skinfollicles (comedones) limited to the face with occasional inflammatorylesions. Acne may be considered to be of moderate severity when a highernumber of inflammatory papules and pustules occur on the skin. Severeacne is said to occur when nodules are the characteristic faciallesions, and involvement of other areas of the body is extensive.Inflammatory acne lesions include papule lesions (small, solid elevationless than 5 mm in diameter, most of the lesion is above the surface ofthe skin), pustule lesions (small circumscribed elevation less than 5 mmin diameter that contains yellow-white exudate), nodule lesions(inflammatory lesion greater than or equal to 5 mm in diameter) and cystlesions (inflammatory lesion that contains yellow-white exudate that isgreater than or equal to 5 mm in diameter). Non-inflammatory lesionsinclude open comedone (blackhead) (lesion in which the follicle openingis widely dilated with the contents protruding out onto the surface ofthe skin, with compacted melanin cells giving the plug a blackappearance) and closed comedone (white head) (lesion in which thefollicle opening is closed, but the sebaceous gland is enlarged by thepressure of the sebum buildup, which in turn cause the skin around thefollicle to thin and become elevated with a white appearance).

The term “synergistically lower” as used herein should be understood torelate to the degree of lowering the side-effects (as measured usingInvestigator Cutaneous Safety Assessment and Local Tolerability Score)caused by topical administration of the active agents in a regimen ofthe invention, as compared with the sum of the side-effects resultingfrom administration of each of the agents separately.

The term “synergistically higher” as used herein should be understood torelate to the degree of therapeutic efficacy (as measured using efficacyresults selected from at least one of IGA success rate, mean reductionin inflammatory lesions count, mean reduction in non-inflammatory lesioncount; and/or PRO results selected from at least one of mean reductionin acne symptom domain, mean reduction in acne impact domain and meanreduction in verbal rating scale) caused by topical administration ofthe active agents in a regimen of the invention, as compared with thesum of the effect resulting from administration of each of the agentsseparately.

The synergistic lower side-effect of the regimen of the invention iscalculated according to the following formula:

(TWIN-V)<(ATRA-V)+(BPO-V)

TWIN—side effect (using the score measurement indicated above and below)measured for the medicament defined in the present invention.

V—side effect (using the score measurement indicated above and below)measured for the vehicle alone.

ATRA—side effect (using the score measurement indicated above and below)measured for ATRA alone.

BPO—side effect (using the score measurement indicated above and below)measured for BPO alone.

When the effect of the medicament of the invention is measured, theside-effect of the vehicle (V) is subtracted from the side-effect of themedicament (TWIN), the net side-effect of the medicament of theinvention (TWIN-V) is numerically lower than the sum of the net clinicalbenefits of each of the individual active agent after subtraction of thevehicle effect from the ATRA and BPO branches, respectively.

The synergistic higher effect of the regimen of the invention iscalculated according to the following formula:

(TWIN-V)>(ATRA-V)+(BPO-V)

-   -   TWIN—therapeutic effect (using the score measurement indicated        above and below) measured for the medicament defined in the        present invention.    -   V—therapeutic effect (using the score measurement indicated        above and below) measured for the vehicle alone.    -   ATRA—therapeutic effect (using the score measurement indicated        above and below) measured for ATRA alone.    -   BPO—therapeutic effect (using the score measurement indicated        above and below) measured for BPO alone.

When the effect of the medicament of the invention is measured, thetherapeutic effect of the vehicle (V) is subtracted from the therapeuticeffect of the medicament (TWIN), the net therapeutic effect of themedicament of the invention (TWIN-V) is numerically higher than the sumof the net clinical benefits of each of the individual active agentafter subtraction of the vehicle effect from the ATRA and BPO branches,respectively.

It is to be noted that the effect of the regimen of the invention,wherein the two active agents are administered in combination is atleast an additive effect and preferentially a synergistic effect. Insome embodiments, the synergistic effect refers to the synergisticlowering of the side effects caused by administration of the activeagents. In some other embodiments, the additive effect of the regimen ofthe invention is attributed to the clinical therapeutic effect of theactive agents. In further embodiments, the synergistic effect of theregimen of the invention is attributed to the clinical therapeuticeffect of the active agents.

It is further noted that any of the above synergistic effects can beattributed to the effect at—at least one of week 2, 4, 8, 12 of theregimen of the invention. In some embodiments, the synergistic effect isprovided at week 4 of the regimen of the invention. In some embodiments,the synergistic effect is provided at week 8 of the regimen of theinvention. In some embodiments, the synergistic effect is provided atweek 12 of the regimen of the invention.

When referring to “improvement”, “improves” and any other lingualderivatives of the term it should be understood to include an additiveor synergistic therapeutic effect of the regimen of the invention. Whenreferring to “improvement of the IGA success rate by at least 20%” itshould be understood to relate to an additive or, in some embodimentsynergistic, improvement of the Investigational Global Assessment (IGA)success rate measured for degree of success in reducing the number ofacne lesions and an improvement in the clinical condition of patientscompared to their baseline condition/score.

The term “potentiates the action of tretinoin in the treatment of acne”should be understood to encompass any therapeutic augmentation of thetreatment of acne achieved by administering tretinoin to a subjectsuffering from acne. The therapeutic effect of administering a topicalmedicament comprising both tretinoin and benzoyl peroxide is eitheradditive or synergistic to the effect of acne treatment with tretinoinalone.

In some embodiments, said medicament is applied at least twice a day. Insome further embodiments, said medicament is applied once a day. In somefurther embodiments, said medicament is applied twice a day. In otherembodiments, said medicament is applied twice a day with a period of atleast 8 hours between administrations. In some embodiments, saidmedicament is applied every other day.

In some embodiments, said medicament is administered for a period of upto 12 weeks. In some embodiments, said medicament is administered for aperiod of 12 weeks. In other embodiments, said medicament isadministered for a period of 1 week. In some embodiments, saidmedicament is administered for a period selected from 1, 2, 4, 8 and 12weeks.

In some embodiments, said amount of said tretinoin or saidpharmaceutically acceptable salt thereof, is at least 0.05% weight.

In other embodiments, said amount of said tretinoin or saidpharmaceutically acceptable salt thereof, is about 0.1% weight.

In some embodiments, said medicament is administered in a singlecomposition, single fixed dose medicament, comprising both said activeagents (BPO and ATRA). In such embodiments, the weight % of the activeagent relates to their weight amount in the single composition. The term“fixed dose medicament” should be understood as meaning a combinationwhose active agents are combined at fixed doses in the same vehicle(single formula) that delivers them together to the point ofapplication.

In further embodiments, said medicament comprises two separatecompositions each one comprising each of said active agents. In suchembodiments, the weight % amount of each active agent relates to each oftheir weight amount in each composition separately. In some embodiments,said two separate compositions of said medicament are administeredconcomitantly. In further embodiments, said two separate compositionsare administered sequentially.

In some embodiments, at least one of said active agents in a medicamentdisclosed hereinabove is encapsulated in a shell. In some otherembodiments, both active agents, BPO and Tretinoin, of said medicamentare encapsulated in a shell. In some embodiments, said shell is aninorganic shell. In further embodiments, said encapsulating shell is ametal oxide or semi-metal oxide inorganic shell.

As used herein unless otherwise indicated the term “microcapsule” refersto a microparticle having a core shell structure, wherein said corecomprises an active agent as defined herein (core material), beingcoated by a shell forming the microcapsule entrapping the core. In someembodiments, the coating/shell is directly deposited on the corematerial. In some embodiments, the core material is solid. In otherembodiments, the core material is semi-solid. In some embodiments, thecore material consists of a solid particle of the active agent. In otherembodiments, the core material comprises a solid particle of the activeagent. In some other embodiments, the core material is in a liquid/oilyphase.

The size of the microcapsules (denoted herein also by the general term“particles” or “microparticles”) as will be referred to herein refers toD90 meaning that 90% of the particles have the stated dimension or less(measured by volume). Thus, for examples, for spherical particles statedto have a diameter of 10 micrometers (“microns”), this means that theparticles have a D90 of 10 microns. The D90 (termed also d(0.9)) may bemeasured by laser diffraction. For particles having a shape other thanspheres, the D90 refers to the mean average of the diameter of aplurality of particles.

In some embodiments, the microcapsules are formed using the process asdisclosed in the following documents (herein incorporated by reference):U.S. Pat. Nos. 6,303,149, 6,238,650, 6,468,509, 6,436,375, US2005037087,US2002064541, and International publications Nos. WO 00/09652,WO00/72806, WO 01/80823, WO 03/03497, WO 03/039510, WO00/71084,WO05/009604, and WO04/81222, disclose sol-gel microcapsules and methodsfor their preparation; EP 0 934 773 and U.S. Pat. No. 6,337,089 teachmicrocapsules containing core material and a capsule wall made oforganopolysiloxane, and their production; EP0941 761 and U.S. Pat. No.6,251,313 also teach the preparation of microcapsules having shell wallsof organopolysiloxane; U.S. Pat. No. 4,931,362 describes a method offorming microcapsules or micromatrix bodies having an interiorwater-immiscible liquid phase containing an active, water-immiscibleingredient. Microcapsules prepared by a sol-gel process are alsodisclosed in GB2416524, U.S. Pat. No. 6,855,335, WO03/066209.

According to some embodiments of the present invention, the coated formof the active ingredient (microcapsule) may be in form of a polymericmicrosponge/silica microsphere where the active ingredient is adsorbed,embedded, impregnated or entrapped in the microsponge/silica microsphereas described for example in U.S. Pat. Nos. 4,690,825; 5,145,675,5,879,716, 5,955,109, and 9,452,137 incorporated herein by reference intheir entirety.

In other embodiments, microcapsules are formed by the encapsulationprocess disclosed in the following publications (herein incorporated byreference): U.S. Pat. Nos. 7,629,394, 9,205,395, US 2015/0328615, US2014/0186630. Controlled release microcapsules: IN01958CH2007,IN02080CH2007, U.S. Pat. Nos. 4,235,872, 4,670,250, EP 0248531, U.S.Pat. Nos. 4,970,031, 5,238,714, WO9321764, U.S. Pat. No. 5,575,987,WO9420075, US 2004/137031, US 2006/003014, US 2010/180464.

The core (wherein it is a solid particulate matter) may be of any shapefor example rod-like, plate-like, ellipsoidal, cubic, or sphericalshape.

In the case of cores having a spherical shape, the diameter (D90) may bein the range of 0.3 to 90 microns, in some embodiments 0.3 to 50microns, in some further embodiments 1 to 50, in some furtherembodiments 5 to 30 microns.

By the term “the diameter (D90) may be in the range of 0.3 to 90microns” is meant that 90% by volume of the particles (in this case theparticle's core) may be less than or equal to a value in the range of0.3 to 90 microns.

For generally cubic-shaped cores or cores having a shape resembling thatof a cube, the mean size of a side may be in the range 0.3 to 80microns, in some embodiments 0.3 to 40 microns, in some furtherembodiments 0.8 to 40 microns, in some further embodiments 4 to 15microns.

For rod-like shaped, ellipsoidal-shaped and plate-like shaped cores, thelargest dimension (that of the longest axis) is typically in the range10 to 100 microns, in some embodiments 15 to 50 microns; and thesmallest dimension is typically in the range 0.5 to 20 microns and insome further embodiments 2 to 10 microns.

According to an embodiment of the present invention, the microcapsules(coated particulate matter) have a diameter (d90) of 0.5 to 100 μm or insome embodiments the diameter of the microcapsules is in the range of 1to 50 μm and in some other embodiments in the range of 5 to 30 μm. It isappreciated that the microcapsules of the present invention are composedof distinct regions of the metal oxide layer in the core material (i.e.the water insoluble particulate matter).

Further according to an embodiment of the present invention the obtainedmetal oxide coating layer has a width (thickness) of 0.1 μm or above, insome embodiments the metal oxide coating layer has a width (thickness)of 0.1-10 μm.

Additionally, according to an embodiment of the present invention theobtained metal oxide coating layer has a width (thickness) of 0.3 μm orabove, in some embodiments the metal oxide coating layer has a width of0.3-10 μm.

Additionally, according to an embodiment of the present invention, thethickness of the metal oxide layer is in the range of 0.1-10 μm. In somefurther embodiments, the thickness of the metal oxide layer is in therange of 0.1-3 μm, and in some further embodiments in the range of 0.1-1μm. The thickness of the metal oxide layer may also be in someembodiments in the range of 0.3 to 3 μm, and in some other embodimentsin the range of 0.3 to 2 μm.

Further according to an embodiment of the present invention the obtainedmetal oxide coating layer has a width (thickness) of about 0.1, 0.2,0.3, 0.5, 0.7, 1, 1.5, 2 or 5 μm or above, in some embodiments up to 10μm.

The width of the metal oxide layer may be determined for example by aTransmission Electron Microscope or Confocal Microscope such that in acircular cross-sectional area of the particle the smallest width is atleast e.g. 0.1 μm (the width is determined as the smallest distance fromthe surface of the particle (i.e. metal oxide surface) to the core-metaloxide interface).

The microcapsules are in some embodiments characterized in that the corematerial is substantially free of the metal oxide and further in thatthe metal oxide layer is substantially free of the core material, e.g.either as particle dispersion (in the nano-metric range of below 0.1 μm)of the particulate matter or as molecular dispersion of the particulatematter.

Thus, according to an embodiment of the present invention, the metaloxide layer is substantially free of core material (either in the formof molecules or as nano-metric particles). The term “substantially free”in this context denotes that the concentration of the molecules of thecore material or the concentration of the nano-metric particles of thecore material is negligible as compared to the metal oxide. Similarly,by the term “the core material is substantially free of the metal oxide”is meant that the concentration of the metal oxide in the core isnegligible as compared to the core material. The microcapsules (i.e.first microcapsules) are in some embodiments non leaching when dispersedin a carrier and in some other embodiments non leaching in an aqueousbased carrier.

According to another embodiment when the microcapsules are prepared by amethod such as spray drying, the core material comprising the activeagent may further comprise up to about 30% w/w, in some embodiments upto about 20% metal oxide and the metal oxide coating layer may furthercomprise up to about 30% w/w, in some embodiments up to about 20% w/w ofthe active agent.

By the term “non-leaching” it is meant that the leaching of theparticulate matter (active agent) from the particles into anaqueous-based liquid is less than 5% w/w, in some embodiments less than3%, in some further embodiments less than 1% w/w in some furtherembodiments less than 0.5% w/w, and in some other embodiments less than0.1% w/w at room temperature (20° C.), under gentle agitation for 1 houror until a steady state concentration is achieved. Typically, theaqueous-based liquid is water. The values indicated above refer to thepercentage of the active agent leached into an aqueous medium relativeto the initial amount of the active agent in the particles. The leachingvalues indicated above refer in some embodiments to a dispersion havinga concentration of the particulate matter in the aqueous medium higherthan 0.1% w/w, in some further embodiments higher than 1% w/w, in somefurther embodiments higher than 3% w/w, and in some other embodimentshigher than 10% w/w. For tretinoin the leaching values indicated aboverefer in some embodiments to a dispersion having a concentration of theparticulate matter in the aqueous medium higher than 0.01% w/w.

According to an embodiment of the present invention the weight ratio ofthe metal oxide to the solid particulate matter is in the range of 1:99to 50:50. The weight ratio of the metal oxide layer to the solidparticulate matter may be also in the range of 3:97 to 50:50, 5:95 to50:50, 10:90 to 50:50, 5:95 to 30:70, 10:90 to 30:70. Further, accordingto an embodiment of the present invention the rate ratio of the metaloxide to the solid particulate matter is in the range of 10:90 to 20:80.

According to another embodiment of the present invention, when spraydrying method is used, the weight ratio of the metal oxide to the solidparticulate matter may be in the range 5:95 to 95:5.

As used herein by the term “uncoated free form” is meant that the activeingredient (BPO or tretinoin) is present in the composition in its“naked” form meaning that it is not intimately embedded, encapsulated,entrapped or encased in a polymeric carrier, and is present in thecomposition in direct contact with the composition carrier. As usedherein by the term “coated form of the active ingredient” is meant thatthe active ingredient is embedded, dispersed, entrapped, or encased,e.g. as a solid dispersion or molecular dispersion in a polymericcarrier which may be an organic or inorganic carrier and which may serveas a matrix for dispersing the active ingredient or as encapsulatedmaterial coating said active ingredient (i.e. the active ingredient ispresent in a core or is a core material encapsulated by a shell composedof a polymeric material which may be an organic or inorganic polymer).

According to another embodiment of the present invention, the coatedform of the active ingredient is second microcapsules comprising a solidparticulate matter of the active ingredient coated by a metal oxidelayer.

Further, according to an embodiment of the present invention, the firstmicrocapsules comprise a solid particulate matter of BPO coated by ametal oxide layer.

According to an embodiment of the present invention, the BPO is in theform of first microcapsules comprising solid particulate matter of BPOcoated by a metal oxide layer and the tretinoin is in the form of secondmicrocapsules comprising a solid particulate matter of the tretinoincoated by a metal oxide layer.

Under these embodiments, the metal oxide coating layer is advantageoussince it is capable of isolating the particulate matter of the activeagent from its surrounding medium, thus preventing cross-reactivity ofthe active agents present in the same composition and yet enables therelease the particulate matter upon application to the surface to betreated.

The term “solid water insoluble agent” refers to a solid material havingsolubility in water of less than 3% w/w, typically less than 1% and attimes less than 0.5% w/w at room temperature (20° C.). The “solid waterinsoluble agent” may have a solubility of less than 0.1% w/w.

The “solid water insoluble agent” may also be termed herein as “solidwater insoluble particulate matter” or “solid particulate matter”.

The term “topical medicament” as used herein (also referred to as“composition”) should be understood to encompass any pharmaceuticalformulation that enables the administration of the active agents to askin tissue of a patient administered with said medicament. Thecomposition or topical medicament of the present invention comprises acarrier. According to an embodiment of the present invention the carrieris in the form of an ointment, a cream, a lotion, an oil, a solution (insome embodiments an aqueous solution), an emulsion, a gel, a paste, amilk, an aerosol, a powder, or a foam. In some embodiments the carrieris an aqueous-based carrier (such as a gel, oil-in water emulsion oroil-in water cream, aqueous solution, foam, lotion, spray).

Thus, the final form of the composition may be any of the above forms,mentioned with respect to the carrier, where the microcapsules aredispersed in the carrier. The final form of the composition may also bein the form of a wash or cleanser.

In some embodiments, the metal oxide is selected from silica, titania,alumina, zirconia, ZnO, and mixtures thereof. In some other embodimentsthe metal oxide is silica.

Moreover, according to an embodiment of the present invention, themicrocapsules (coated particulate matter) have a diameter of 0.5-100 μm.In some embodiments, the particles have a diameter of 0.8-100 μm, insome further embodiments 1-50 μm and in some other embodiments 2-30 μm.

According to certain embodiments of the present invention, the surfaceof the metal oxide later of the coated particulate matter may bechemically modified by organic groups, in some embodiments hydrophobicgroups, attached to its surface.

The hydrophobic groups may be for example an alkyl groups (such alkylgroups may be further substituted with one or more fluoro atoms), arylgroups (such as benzyl or phenyl), and combinations thereof. The groupsmay be as described below with respect to the process.

In some embodiments the topical medicament comprises tretinoin or itspharmaceutically acceptable salt, hydrate or solvate. Suitablepharmaceutically acceptable salts of the active component(s) (i.e.tretinoin) of this invention include inorganic salts such as: ammonium,alkali metals to include lithium, sodium, potassium, cesium; alkalineearth metals to include calcium, magnesium, aluminium; zinc, barium; orquaternary ammoniums; or organic salts such as arginine, organic aminesto include aliphatic organic amines, aromatic amines, t-butylamines,(N-benzylphenethylamine), dicyclohexylamines, dimethylamines,diethanolamines, ethanolamines, ethylenediamines, imidazoles, lysines,methylamines, N-methyl-D-glucamines, N,N′-dibenzylethylenediamines,pyridines, picolinates, piperazines, tris(hydroxymethyl)methylamines,triethylamines, triethanolamines, trimethylamines, or ureas.

In one embodiment, the term “about”, refers to a deviance of between0.0001-5% from the indicated number or range of numbers. In oneembodiment, the term “about”, refers to a deviance of between 1-10% fromthe indicated number or range of numbers.

The following examples are presented in order to more fully illustratethe preferred embodiments of the invention. They should in no way,however, be construed as limiting the broad scope of the invention.

EXAMPLES Example 1

Product 3149 is a combination formulation of encapsulated benzoylperoxide (E-BPO) 3%, prepared as described in US patent publication2010-0016443, and encapsulated All Trans Retinoic Acid (E-ATRA) 0.1%,prepared as described in US patent publication US 2012/0202695.

Product 3156 is a combination formulation of similar E-BPO 3% andsimilar E-ATRA 0.05%.

A clinical trial was designed to assess whether the combination of E-BPOand E-ATRA provides safe and synergistic efficacy as compared to use ofeither product alone in the treatment of acne vulgaris. Products 3149and 3156 provide improved outcomes due the stability of the product, asdescribed in US patent publication 2013/0095185, and lead to increasedpatient compliance.

The purpose of the study was to assess the efficacy, safety, andtolerability of Products 3149 and 3156 in comparison to the individualcomponents, E-BPO 3%, E-ATRA 0.1%, E-ATRA 0.05%, and vehicle (placebo).

This was a randomized, double-blind, multicenter, parallel group,active- and vehicle-controlled study of the efficacy, tolerability, andsafety of Products 3149 and 3156 for the treatment of acne vulgaris.

Approximately 720 subjects, age 9 and older, with moderate to severefacial acne (rated 3 or 4 on the 5-point Investigator's GlobalAssessment [IGA]) were enrolled at up to 37 sites. Participants wererandomized 1:1:1:1:1:1 to receive once daily treatment with E-BPO/E-ATRA(3%/0.05%); E-BPO/E-ATRA (3%/0.1%); E-BPO (3%); E-ATRA (0.05%); E-ATRA(0.1%); and vehicle cream. After the screening period, qualifiedsubjects were randomized at the Baseline visit and treated for 12 weeks.

Efficacy assessments included facial lesion counts (inflammatory andnon-inflammatory) and IGA assessment ranging from 0 (Clear) to 4(Severe). Investigators were provided with instructions for lesioncounts to ensure consistency of procedure. Patient reported outcomes(PRO) were assessed at Baseline, Weeks 4, 8, and 12 or earlytermination. Safety was assessed at all visits and included monitoringlocal and systemic adverse experiences; the Investigator CutaneousSafety Assessment rating of hyper- and hypopigmentation, erythema andscaling on a scale ranging from 0 (None) to 3 (Severe); and the subjectassessment of Local Tolerability rating itching, burning, and stingingon a scale ranging from 0 (None) to 3 (Severe).

Subjects returned to centers for cutaneous safety and local tolerabilityassessments at Weeks 2, 4, 8, and 12; and IGA and lesion counts wererepeated at Weeks 4, 8, and 12. Adverse events and concomitantmedications were assessed throughout the treatment period.

All products were supplied in 80-gram pumps (50 g of it is the cream).One pea sized amount was applied on each area of the face (chin, leftcheek, right cheek, nose, and forehead) once daily, at bedtime, for 12weeks.

TABLE 1 Investigator's Global Assessment Scale for Acne Severity ScoreGrade Description 0 Clear Normal, clear skin with no evidence of acnevulgaris 1 Almost clear Rare non-inflammatory lesions present, with rarenon-inflamedpapules (papules must be resolving and may behyperpigmented, though not pink-red) 2 Mild Some non-inflammatorylesions are present, with few inflammatory lesions (papules/ pustulesonly; no nodulo-cystic lesions) 3 Moderate Multiple Non-inflammatorylesions and, inflammatory lesions are evident: several to many comedonesand papules/pustules, and there may or may not be one smallnodulo-cystic lesion 4 Severe Inflammatory lesions are more apparent,many comedones and papules/pustules, there may or may not be a fewnodulo- cystic lesions

Inflammatory Lesions Definitions

Papule: A small, solid elevation less than 5 mm in diameter. Most of thelesion is above the surface of the skin.

Pustule: A small circumscribed elevation less than 5 mm in diameter thatcontains yellow-white exudate.

Nodule: An inflammatory lesion greater than or equal to 5 mm indiameter.

Cyst: An inflammatory lesion that contains yellow-white exudate that isgreater than or equal to 5 mm in diameter.

Non-Inflammatory Lesions Definition

Open Comedone (Black head): A lesion in which the follicle opening iswidely dilated with the contents protruding out onto the surface of theskin, with compacted melanin cells giving the plug a black appearance.

Closed Comedone (White head): A lesion in which the follicle opening isclosed, but the sebaceous gland is enlarged by the pressure of the sebumbuildup, which in turn cause the skin around the follicle to thin andbecome elevated with a white appearance.

TABLE 2 Cutaneous Safety Assessment (Investigator) Score RatingDefinition Erythema 0 None No erythema 1 Mild Slight pinkness present 2Moderate Definite redness, easily recognized 3 Severe Intense rednessScaling 0 None No scaling 1 Mild Barely perceptible shedding, noticeableonly on light scratching or rubbing 2 Moderate Obvious but not profuseshedding 3 Severe Heavy scale production Pigmentation 0 None Nodisturbance of pigmentation 1 Mild Barely perceptible pigment change 2Moderate Markedly darker or lighter 3 Severe Complete de-pigmentation orsevere hyperpigmentation

TABLE 3 Local Tolerability Scoring (Subject) Score Rating DefinitionItching 0 None No itching 1 Mild Slight itching, not really bothersome 2Moderate Definite itching that is somewhat bothersome 3 Severe Intenseitching that may interrupt daily activities and/or sleep Burning 0 NoneNo burning 1 Mild Slight burning sensation; not really bothersome 2Moderate Definite warm, burning sensation that is somewhat bothersome 3Severe Hot burning sensation that causes definite discomfort and mayinterrupt daily activities or sleep Stinging 0 None No stinging 1 MildSlight stinging sensation; not really bothersome 2 Moderate Definitestinging sensation that is somewhat bothersome 3 Severe Severe stingingsensation that causes definite discomfort and may interrupt dailyactivities or sleep

Example 2

Efficacy:

Co-primary efficacy variables were evaluated in this study, and includethe following:

-   -   Investigator's Global Assessment (IGA)    -   Lesion count (separately for inflammatory and non-inflammatory)

The co-primary endpoints are:

-   -   Proportion of subjects with an assessment of clear or almost        clear with at least a 2-grade improvement in IGA at Week 12    -   Absolute and percent reduction from Baseline in lesion count on        the face at Week 12 (separately for inflammatory and        non-inflammatory lesions)

Safety:

Safety variables include Investigator Cutaneous Safety Assessment score,subject's tolerability assessment scores, treatment-emergent adverseevents (AEs), SAES, treatment related AEs, AEs leading to studydiscontinuation, concomitant medications, clinical chemistry, hematologyand urinalysis, and ECG evaluation.

Success Criteria:

The following statistical comparisons (both numerically andinferentially) were performed:

-   -   Product 3149 (E BPO/E ATRA 3%/0.1%) versus E-BPO 3%, E-ATRA 0.1%        and vehicle    -   Product 3156 (E BPO/E ATRA (3%/0.05%) versus E-BPO 3%, E-ATRA        0.05% and vehicle.

Patient Reported Outcome Questionnaire

The Patient-Reported Evaluation of Facial Acne (PRE-FACE) and PatientFacial Acne Severity Assessment were assessed at study visits 1-6,including screening, baseline, and at Weeks 2, 4, 8, and 12 or earlytermination (ET), to capture the patient-reported experience of acnevulgaris. The PRE-FACE contains 7-items that constitute two domains. Theacne symptom domain (ASD) assesses the severity of acne symptoms (fouritems) on an 11-point numeric rating scale (NRS) ranging from 0=none to10=as bad as you can imagine. The acne impact domain (AID) assesses theimpacts of acne on the way a patient feels (three items) on an 11-pointNRS ranging from 0=not at all to 10=extremely. Higher scores on thePatient Reported Outcome (PRO) questionnaire indicate higher severity ofsymptoms and impacts associated with acne vulgaris. In addition, thePatient Facial Acne Severity Assessment was assesed along with thePRE-FACE, which is a global item assessing patient-reported overallseverity of acne vulgaris on a 5 point verbal rating scale (VRS),ranging from 0 (no acne) to 4 (very severe acne). Respondents were alsoprovided with verbal descriptors to facilitate their ratings.

Results:

TABLE 4 Results for product 3149 at 12 weeks Product 3149 E-BPO 3%E-ATRA 0.1% Vehicle Efficacy Results 116 subjects 118 subjects 118subjects 115 subjects IGA success rate 39.7% 22.1% 31.7% 12.3% Meanreduction in 16. 9 (64.0%) 13.8 (49.4%) 14.9 (57.1%) 11.5 (42.2%)inflammatory lesions count Mean reduction in 23.6 (53.3%) 16.2 (37.7%)23.8 (57.1%) 13.7 (32.4%) non-inflammatory lesions count

TABLE 5 Results for product 3149 at 4 weeks Product 3149 E-BPO 3% E-ATRA0.1% Vehicle Efficacy Results 116 subjects 118 subjects 118 subjects 115subjects IGA success rate 3.1% 5.4% 4.85% 4.5% Mean reduction in  8.5(32.8%) 8.0 (29.3%)  8.4 (33.2%) 7.2 (26.3%) inflammatory lesions countMean reduction in 11.8 (27.6%) 7.7 (18.4%) 10.1 (25.9%) 7.1 (17.9%)non-inflammatory lesions count

TABLE 6 Results for product 3149 at 8 weeks Product 3149 E-BPO 3% E-ATRA0.1% Vehicle Efficacy Results 116 subjects 118 subjects 118 subjects 115subjects IGA success rate 14.9% 12.7% 9.3% 9.4% Mean reduction in 13.3(50.4%)  9.6 (40.9%) 12.6 (49.3%)  9.6 (34.1%) inflammatory lesionscount Mean reduction in 18.5 (41.9%) 10.9 (23.7%)   18 (43.1%) 12.0(29.2%) non-inflammatory lesions count

TABLE 7 Results for product 3156 at 12 weeks Product 3156 E-BPO 3%E-ATRA 0.05% Vehicle Efficacy Results 117 subjects 118 subjects 118subjects 115 subjects IGA success rate 27.4% 22.1% 24.9% 12.3% Meanreduction in 17.0 (60.8%) 13.8 (49.4%) 13.9 (51.7%) 11.5 (42.2%)inflammatory lesions count Mean reduction in 23.7 (54.9%) 16.2 (37.7%)17.8 (44.6%) 13.7 (32.4%) non-inflammatory lesions count

TABLE 8 Results for product 3156 at 4 weeks Product 3156 E-BPO 3% E-ATRA0.05% Vehicle Efficacy Results 117 subjects 118 subjects 118 subjects115 subjects IGA success rate 3.7% 5.4% 1.8% 4.5% Mean reduction in  9.3(31.8%) 8.0 (29.3%) 7.2 (28.4%) 7.2 (26.3%) inflammatory lesions countMean reduction in 11.4 (27.7%) 7.7 (18.4%) 6.8 (18.8%) 7.1 (17.9%)non-inflammatory lesions count

TABLE 9 Results for product 3156 at 8 weeks Product 3156 E-BPO 3% E-ATRA0.05% Vehicle Efficacy Results 117 subjects 118 subjects 118 subjects115 subjects IGA success rate 13.3% 12.7% 8.4% 9.4% Mean reduction in13.5 (48.5%) 11.7 (40.9%) 10.5 (39.6%)  9.6 (34.1%) inflammatory lesionscount Mean reduction in 19.1 (45.4%) 10.9 (23.7%) 13.0 (32.4%) 12.0(29.2%) non-inflammatory lesions count

TABLE 10 Results for product 3149 at 2 weeks Product E-BPO E-ATRA 31493% 0.1% Vehicle Patient Reported 116 118 118 115 Outcome Resultssubjects subjects subjects subjects Mean reduction in 0.72 0.53 0.690.49 Acne Symptom Domain (ASD) Mean reduction in 1.32 0.88 0.83 0.72Acne Impact Domain (AID) Mean reduction in 0.1 0.2 0.1 0.3 verbal ratingscale (VRS)

TABLE 11 Results for product 3149 at 4 weeks Product E-BPO E-ATRA 31493% 0.1% Vehicle 116 118 118 115 PRO Results subjects subjects subjectssubjects Mean reduction in 1.21 0.96 1.18 0.78 Acne Symptom Domain (ASD)Mean reduction in 1.97 1.51 1.44 0.92 Acne Impact Domain (AID) Meanreduction in 0.4 0.5 0.4 0.4 verbal rating scale (VRS)

TABLE 12 Results for product 3149 at 8 weeks Product E-BPO E-ATRA 31493% 0.1% Vehicle 116 118 118 115 PRO Results subjects subjects subjectssubjects Mean reduction in 1.91 1.35 1.92 1.24 Acne Symptom Domain (ASD)Mean reduction in 2.65 2.09 2.36 1.44 Acne Impact Domain (AID) Meanreduction in 0.6 0.5 0.5 0.6 verbal rating scale (VRS)

TABLE 13 Results for product 3149 at 12 weeks Product E-BPO E-ATRA 31493% 0.1% Vehicle 116 118 118 115 PRO Results subjects subjects subjectssubjects Mean reduction in 2.72 1.97 2.57 1.44 Acne Symptom Domain (ASD)Mean reduction in 3.52 2.53 3.04 1.8 Acne Impact Domain (AID) Meanreduction in 1.0 0.8 0.9 0.6 verbal rating scale (VRS)

TABLE 14 Results for product 3156 at 2 weeks Product E-BPO E-ATRA 31563% 0.05% Vehicle 117 118 118 115 PRO Results subjects subjects subjectssubjects Acne Symptom 0.72 0.53 0.79 0.49 Domain (ASD) Acne ImpactDomain 1.71 0.88 1.03 0.72 (AID) Mean reduction in 0.4 0.2 0.2 0.3verbal rating scale (VRS)

TABLE 15 Results for product 3156 at 4 weeks Product E-BPO E-ATRA 31563% 0.05% Vehicle 117 118 118 115 PRO Results subjects subjects subjectssubjects Acne Symptom 1.26 0.96 1.29 0.78 Domain (ASD) Acne ImpactDomain 2.22 1.51 1.61 0.92 (AID) Mean reduction in 0.6 0.5 0.4 0.4verbal rating scale (VRS)

TABLE 16 Results for product 3156 at 8 weeks Product E-BPO E-ATRA 31563% 0.05% Vehicle 117 118 118 115 PRO Results subjects subjects subjectssubjects Acne Symptom 2.03 1.35 1.69 1.24 Domain (ASD) Acne ImpactDomain 3.16 2.09 2.16 1.44 (AID) Mean reduction in 0.8 0.5 0.6 0.6verbal rating scale (VRS)

TABLE 17 Results for product 3156 at 12 weeks Product E-BPO E-ATRA 31563% 0.05% Vehicle 117 118 118 115 PRO Results subjects subjects subjectssubjects Acne Symptom 2.68 1.97 2.40 1.44 Domain (ASD) Acne ImpactDomain 3.94 2.53 2.82 1.8 (AID) Mean reduction in 1.1 0.8 0.8 0.6 verbalrating scale (VRS)

TABLE 18 Results for product 3149 at week 12 Product E-BPO E-ATRA 31493% 0.1% Vehicle Tolerability 116 118 117 116 Results subjects subjectssubjects subjects Erythema 35 (31.0%) 24 (20.3%) 23 (19.8%) 26 (22.4%)Mild 18 (15.9%) 16 (13.6%) 13 (11.2%) 19 (16.4%) Moderate 15 (13.3%) 8(6.8%) 9 (7.8%) 7 (6.0%) Severe 2 (1.8%) 0 (0.0%) 1 (0.9%) 0 (0.0%)Scaling 47 (41.6%) 21 (17.8%) 54 (46.6%) 25 (21.6%) Mild 37 (32.7%) 14(11.9%) 37 (31.9%) 23 (19.8%) Moderate 10 (8.8%)  7 (5.9%) 17 (14.7%) 2(1.7%) Severe 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) Burning 43 (38.1%) 17(14.4%) 41 (35.3%) 13 (11.2%) Mild 28 (24.8%) 15 (12.7%) 28 (24.1%) 11(9.5%)  Moderate 10 (8.8%)  2 (1.7%) 11 (9.5%)  2 (1.7%) Severe  5(4.4%) 0 (0.0%) 2 (1.7%) 0 (0.0%) Stinging 35 (31.0%) 20 (16.9%) 35(30.2%) 16 (13.8%) Mild 25 (22.1%) 13 (11.0%) 23 (19.8%) 15 (12.9%)Moderate 5 (4.4%) 7 (5.9%) 10 (8.6%)  1 (0.9%) Severe 5 (4.4%) 0 (0.0%)2 (1.7%) 0 (0.0%) Pigmentation 15 (13.3%) 12 (10.2%) 14 (12.2%) 17(14.7%) Mild 11 (9.7%)  9 (7.6%) 10 (8.7%)  10 (8.6%)  Moderate 4 (3.5%)3 (2.5%) 3 (2.6%) 7 (6.0%) Severe 0 (0.0%) 0 (0.0%) 1 (0.9%) 0 (0.0%)Itching 28 (24.8%) 22 (18.6%) 39 (33.6%) 22 (19.0%) Mild 20 (17.7%) 19(16.1%) 29 (25.0%) 19 (16.4%) Moderate 7 (6.2%) 3 (2.5%) 10 (8.6%)  3(2.6%) Severe 1 (0.9%) 0 (0.0%) 0 (0.0%) 0 (0.0%)

TABLE 19 Results for product 3149 at 12 weeks Erythema Results (changein number Product E-BPO E-ATRA of adverse events 3149 3% 0.1% Vehiclecompared to 116 118 117 116 baseline) subjects subjects subjectssubjects week 2, N 111 114 115 114 Mild −6 5 −2 3 Moderate 4 −4 −1 −5Severe 1 0 0 0 week 4, N 109 114 106 113 Mild −7 0 −3 6 Moderate −6 −7−11 −14 Severe 1 0 0 0 Week 8, N 102 104 98 110 Mild −2 −3 −11 8Moderate −5 −11 −13 −13 Severe 1 0 0 0 Week 12, N 97 101 93 102 Mild −15−2 −13 0 Moderate −14 −14 −19 −17 Severe 0 0 1 0

TABLE 20 Results for product 3149 at 2 weeks Product E-BPO E-ATRA 31493% 0.1% Vehicle Tolerability 116 118 117 116 Results subjects subjectssubjects subjects Erythema 35 (31.0%) 24 (20.3%) 23 (19.8%) 26 (22.4%)Mild 18 (15.9%) 16 (13.6%) 13 (11.2%) 19 (16.4%) Moderate 15 (13.3%) 8(6.8%) 9 (7.8%) 7 (6.0%) Severe 2 (1.8%) 0 (0.0%) 1 (0.9%) 0 (0.0%)Scaling 47 (41.6%) 21 (17.8%) 54 (46.6%) 25 (21.6%) Mild 37 (32.7%) 14(11.9%) 37 (31.9%) 23 (19.8%) Moderate 10 (8.8%)  7 (5.9%) 17 (14.7%) 2(1.7%) Severe 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) Burning 43 (38.1%) 17(14.4%) 41 (35.3%) 13 (11.2%) Mild 28 (24.8%) 15 (12.7%) 28 (24.1%) 11(9.5%)  Moderate 10 (8.8%)  2 (1.7%) 11 (9.5%)  2 (1.7%) Severe 5 (4.4%)0 (0.0%) 2 (1.7%) 0 (0.0%) Stinging 35 (31.0%) 20 (16.9%) 35 (30.2%) 16(13.8%) Mild 25 (22.1%) 13 (11.0%) 23 (19.8%) 15 (12.9%) Moderate 5(4.4%) 7 (5.9%) 10 (8.6%)  1 (0.9%) Severe 5 (4.4%) 0 (0.0%) 2 (1.7%) 0(0.0%) Pigmentation 15 (13.3%) 12 (10.2%) 14 (12.2%) 17 (14.7%) Mild 11(9.7%)  9 (7.6%) 10 (8.7%)  10 (8.6%)  Moderate 4 (3.5%) 3 (2.5%) 3(2.6%) 7 (6.0%) Severe 0 (0.0%) 0 (0.0%) 1 (0.9%) 0 (0.0%) Itching 28(24.8%) 22 (18.6%) 39 (33.6%) 22 (19.0%) Mild 20 (17.7%) 19 (16.1%) 29(25.0%) 19 (16.4%) Moderate 7 (6.2%) 3 (2.5%) 10 (8.6%)  3 (2.6%) Severe1 (0.9%) 0 (0.0%) 0 (0.0%) 0 (0.0%)

TABLE 21 Results for product 3156 at week 12 Product E-BPO E-ATRA 31563% 0.05% Vehicle Tolerability 117 118 120 116 Results subjects subjectssubjects subjects Erythema 30 (25.9%) 24 (20.3%) 29 (24.2%) 26 (22.4%)mild 19 (16.4%) 16 (13.6%) 17 (14.2%) 19 (16.4%) moderate 10 (8.6%)  8(6.8%) 11 (9.2%)  7 (6.0%) severe 1 (0.9%) 0 (0.0%) 1 (0.8%) 0 (0.0%)Scaling 47 (40.5%) 21 (17.8%) 48 (40.0%) 25 (21.6%) mild 29 (25.0%) 14(11.9%) 30 (25.0%) 23 (19.8%) moderate 16 (13.8%) 7 (5.9%) 16 (13.3%) 2(1.7%) severe 2 (1.7%) 0 (0.0%) 2 (1.7%) 0 (0.0%) Burning 52 (44.8%) 17(14.4%) 41 (34.2%) 13 (11.2%) mild 31 (26.7%) 15 (12.7%) 23 (19.2%) 11(9.5%)  moderate 16 (13.8%) 2 (1.7%) 17 (14.2%) 2 (1.7%) severe 5 (4.3%)0 (0.0%) 1 (0.8%) 0 (0.0%) Stinging 42 (36.2%) 20 (16.9%) 31 (25.8%) 16(13.8%) mild 30 (25.9%) 13 (11.0%) 23 (19.2%) 15 (12.9%) moderate 8(6.9%) 7 (5.9%) 8 (6.7%) 1 (0.9%) severe 4 (3.4%) 0 (0.0%) 0 (0.0%) 0(0.0%) Pigmentation 16 (13.8%) 12 (10.2%) 23 (19.2%) 17 (14.7%) mild 13(11.2%) 9 (7.6%) 19 (15.8%) 10 (8.6%)  moderate 3 (2.6%) 3 (2.5%) 4(3.3%) 7 (6.0%) severe 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) Itching 32(27.6%) 22 (18.6%) 35 (29.2%) 22 (19.0%) mild 25 (21.6%) 19 (16.1%) 26(21.7%) 19 (16.4%) moderate 6 (5.2%) 3 (2.5%) 8 (6.7%) 3 (2.6%) severe 1(0.9%) 0 (0.0%) 1 (0.8%) 0 (0.0%)

Conclusions:

The above results clearly show synergistic effects of the claimedregimens. For example:

-   -   Synergistically lower side effects could be observed in week 12        for product 3149 in scaling, stinging, burning, itching (Table        18), for product 3156 in pigmentation, itching (Table 21).    -   Synergistically higher efficacy could be observed in week 4 for        product 3149 in mean reduction in non-inflammatory lesion count        (Table 5), week 8 for product 3149 in IGA success rate, mean        reduction in non-inflammatory lesion count (Table 6), in week 4        for product 3156 in reduction in inflammatory and        non-inflammatory lesion count (Table 8), week 8 for product 3156        in IGA success rate, mean reduction in inflammatory lesion        count, mean reduction in non-inflammatory lesion count (Table        9), in week 12 for product 3156 in mean reduction in        inflammatory and non-inflammatory lesion count (Table 7).

Surprisingly, both combinations were found to be significantly betterthan the single active ingredients. Furthermore, the tolerability andsafety of the combination therapy and regimen of the invention was shownto have synergistic effect as compared with each compositionadministered alone.

While certain features of the invention have been illustrated anddescribed herein, many modifications, substitutions, changes, andequivalents will now occur to those of ordinary skill in the art. It is,therefore, to be understood that the appended claims are intended tocover all such modifications and changes as fall within the true spiritof the invention.

1. A method of treating acne comprising: topically applying onto anaffected skin area of a subject in need thereof, once a day for a periodof time of up to 12 weeks, a topical medicament which comprises theactive agents: Tretinoin or a pharmaceutically acceptable salt thereof,in an amount of about 0.05% to about 0.1% weight; and Benzoyl Peroxidein an amount of between about 3% to about 6% weight.
 2. The methodaccording to claim 1, wherein the score of at least one parameterevaluated by an Investigator Cutaneous Safety Assessment issynergistically lower than the score of the parameters evaluated withthe same treatment regimen with each of the active agents separately. 3.The method according to claim 2, wherein said at least one parameterevaluated by the Investigator Cutaneous Safety Assessment is selectedfrom erythema, scaling, pigmentation and any combinations thereof. 4.The method according to claim 1, wherein the score of at least oneparameter evaluated by a Local Tolerability Score is synergisticallylower than the score of the parameters evaluated with the same treatmentregimen with each of the active agents separately.
 5. The methodaccording to claim 4, wherein said at least one parameter evaluated bythe Local Tolerability score is selected from Itching, Burning,Stinging, and any combinations thereof.
 6. The method according to claim1, wherein said topical medicament in a single dose medicamentcomprising both said active agents.
 7. The method according to claim 1,wherein said method reduces at least one of: (i) the number ofinflammatory acne lesions by at least 50%; or (ii) the number ofnon-inflammatory acne lesions by at least 40%.
 8. The method accordingto claim 7, wherein said method reduces the number of non-inflammatoryacne lesions by at least 40%.
 9. The method according to claim 7,wherein said method reduces the number of inflammatory acne lesions byat least 50%.
 10. The method according to claim 7, wherein said methodreduces the number of inflammatory acne lesions by at least 50%; and thenumber of non-inflammatory acne lesions by at least 40%.
 11. The methodaccording to claim 1, wherein said method improves the IGA success rateby at least 20% compared to the baseline score.
 12. The method accordingto claim 1, wherein after two weeks storage at 40° C. of the topicalmedicament, the concentration of all-trans 5,6-epoxy retinoic acid islower than 1%.
 13. A method according to claim 1, wherein after twoweeks storage at 40° C. of the topical medicament, the degradation ofsaid tretinoin is less than 2.5%.
 14. The method according to claim 1,wherein said method potentiates the action of tretinoin in the treatmentof acne.
 15. The method according to claim 1, wherein the release rateof said tretinoin from said topical medicament is less than 60% per h.16. The method according to claim 1, wherein the release rate of saidtretinoin from said topical medicament is less than 60% per h in amedium of 70% IPA (isopropyl alcohol) and 30% water at room temperature.17. The method according to claim 1, wherein said at least one activeagent of said medicament is encapsulated in a shell.
 18. The methodaccording to claim 1, wherein both active agents, BPO and Tretinoin, ofsaid medicament are encapsulated in a shell.
 19. The method according toclaim 18, wherein said shell is an inorganic shell.
 20. The methodaccording to claim 19, wherein said shell is a metal oxide or semi-metaloxide inorganic shell.
 21. The method according to claim 1, wherein thescore of at least one efficacy parameter is synergistically higher thanthe parameter evaluated with the same treatment regimen with each of theactive agents separately.
 22. The method according to claim 21, whereinsaid efficacy parameter is selected from at least one of IGA successrate, mean reduction in inflammatory lesions count, mean reduction innon-inflammatory lesion count, mean reduction in acne symptom domain,mean reduction in acne impact domain and mean reduction in verbal ratingscale.